Harvoni (ledipasvir/sofosbuvir) — United Healthcare
Chronic hepatitis C genotype 1 or 4 infection in liver transplant recipients without cirrhosis or with compensated cirrhosis
Initial criteria
- Diagnosis of chronic hepatitis C genotype 1 or 4 infection
- Patient has previously received a liver transplant
- One of the following: (1) Patient is without cirrhosis OR (2) Patient has compensated cirrhosis (Child-Pugh A) and is without decompensated liver disease (Child-Pugh B or C)
- Patient is not receiving Harvoni in combination with another HCV direct acting antiviral agent
- Patient will receive Harvoni in combination with ribavirin
Approval duration
12 weeks